2007 statistical report

Tuolumne County Emergency Medical Services Agency

2007 Annual Statistical Report

February 28, 2008 Prepared by: Clarence I. Teem, EMS Coordinator Tuolumne County Emergency Medical Services Agency 20111 Cedar Road North, Sonora California 95370 (209) 533-7460

Tuolumne County EMS Agency 2007 Annual Report Page ii

Tuolumne County EMS Agency 2007 Annual Report Page iii

Table of Contents INTRODUCTION…………………………………………………………………………..…..1 OVERVIEW OF CALL VOLUME ……….…….…………………………….…………….....3 CALL DISPOSITION/LEVEL OF CARE.………………………………………………..…..7 RESPONSE TIMES……………………………………………………………………………9 PATIENT AND HOSPITAL DATA……………………………………………………..…….12

EMS PATIENTS RESIDENCY STATUS……………………………………………………14

EMS PATIENT DEMOGRAPHICS….….……………………………………………………18 TRAUMA SYSTEM……………………………………………………………..……………..18 ADVANCED LIFE SUPPORT SKILLS………………………………………………………21 ADVANCED LIFE SUPPORT MEDICATIONS.............................................................. 22 SUMMARY…………………………………………………………………………………......24

Tuolumne County EMS Agency 2007 Annual Report Page 1

INTRODUCTION The 2007 Annual Statistical Report compiles and condenses an entire year’s worth of call volume, response time and patient demographic information about the Tuolumne County EMS system for public review. The data included in this report is derived from pre-hospital patient care records (PCRs) completed by Tuolumne County Ambulance personnel and base/receiving logs completed by emergency department personnel from Tuolumne General Hospital and Sonora Regional Medical Center. Since July 1, 1993, Tuolumne County Ambulance has collected PCR information using the software program EMS DataProJ (formerly the EMS Database System) provided for their use by the Tuolumne County EMS Agency. Once entered in EMS DataProJ, the data is submitted in an electronic format to the EMS agency where the data is imported into a central version of EMS DataProJ. The EMS agency then validates and combines the data submitted by Tuolumne County Ambulance with patient outcome data derived from the base/receiving logs submitted by the two Base Hospitals, Tuolumne General Hospital and Sonora Regional Medical Center. In September 2000, Tuolumne County Ambulance, with the assistance of the EMS agency, initiated a program for completing PCRs using EMS OutfielderJ (a laptop based PCR data entry program developed by CompuCounsel, now called Inspironix, of Sacramento in conjunction with Manteca District Ambulance). EMS OutfielderJ has replaced hand-written PCR forms and billing tickets. EMS OutfielderJ provides immediate data availability for daily quality assurance/quality improvement reviews and imports patient billing information directly into the billing system used by Tuolumne County Ambulance. The Tuolumne County Emergency Medical Services (EMS) System is comprised of four 9-1-1 answering points including Tuolumne County Sheriff’s Dispatch, City of Sonora Police Department Dispatch, CHP Dispatch and Mariposa County Sheriff’s Dispatch; Ambulance dispatching provided by the Tuolumne County Sheriff’s Dispatch Center. Basic life support (BLS) first response services provided by Tuolumne County Fire Dept., Tuolumne City Fire Dist., Columbia College Fire Dept., Twain Harte Fire Dist., Columbia Fire Dist., Sonora City Fire Dept., Miwuk-Sugarpine Fire Dist., Tuolumne City Fire Dist., and the Groveland Fire Dist. Special BLS response services from U.S. Forest Service, County Search and Rescue, Don Pedro Recreation Agency, Dodge Ridge Ski Patrol Advanced life support (ALS) service provided by Tuolumne County Ambulance Service. Mercy Medical Transport in Mariposa County provides the Lake Don Pedro area ALS Ambulance service. Petroleum Helicopter Inc. (PHI) stationed at Columbia Airport and day-to-day mutual aid by the California Highway Patrol (CHP) Air Operations Division, Medi-Flight of Northern California, CALSTAR and R.E.A.C.H. Air Ambulance.


In June 2003, grant funds were made available to the Tuolumne County EMS Agency for the purpose of purchasing and installing EMSystem™ communication software and related computer hardware for the emergency departments of Tuolumne General Hospital and Sonora Regional Medical Center and the EMS agency office. In early 2004, EMSystem™ linked Tuolumne County’s EMS system with the other ten (10) counties of OES Region IV enabling Tuolumne General Hospital, as the county’s Disaster Control Facility, to view real-time emergency department availability when determining patient disbursement during a multi-casualty incident (MCI). In 2004, The Tuolumne County Emergency Medical Services System developed and implemented a Trauma Plan, in conjunction with Memorial Medical Center, Doctors Medical Center of Modesto, Mountain Valley EMS Agency, El Dorado County EMS Agency, Central California EMS Agency, Northern California EMS Agency, Sacramento County EMS Agency, and Santa Barbara County EMS Agency. The Trauma Plan provides a framework that assures that the citizens and visitors of Tuolumne County receive comprehensive prehospital and hospital trauma care. Tuolumne County relies on Trauma Centers throughout Northern California for in-hospital trauma care. Air Ambulances are used as the primary means of transportation for patients meeting Tuolumne County’s major trauma patient criteria.

OVERVIEW OF CALL VOLUME As illustrated in the graphs below, in 2007 there was a slight increase in calls for EMS services from 2005. 2007 has now surpassed 2004 as the busiest year on record for emergency medical service (EMS) requests in Tuolumne County. Unless otherwise specified EMS requests include both scene and transfer call types.

Call Volume 2001-2007

4344 43854567

47804645

4765 4849

4000410042004300440045004600470048004900

2001 2002 2003 2004 2005 2006 2007

EMS Requests by Month and Year

Year

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2001

383

355

358

357

330

377

396

379

366

354

308

382

2002

383

327

407

344

370

330

426

436

354

352

326

330

2003 390 318 380 363 325 368 442 381 383 393 403 421

2004 392 397 385 337 391 376 453 425 390 389 376 469 2005 363 369 399 354 414 389 467 414 365 377 355 379 2006 379 396 428 403 395 450 419 356 391 344 402 402 2007 407 373 406 386 443 397 399 414 411 380 389 444


2007 Call Volume by Month

444

389380

411414399397

443

386406

373

407

320340360380400420440460

Jan-07 Feb-07

Mar-07 Apr-07 May-07

Jun-07 Jul-07 Aug-07

Sep-07

Oct-07 Nov-07

Dec-07

As illustrated below, Medics 10 and 11 responded to the majority of all EMS requests. The Sonora area has a call volume rate more than three times greater than any other area of the County.

2007 Calls Volume by Unit

324

872

152

546

1185

1863

60

200400600800

100012001400160018002000

Unit Notnoted

Medic 10 Medic 11 Medic 12 Medic 13 Medic 14 Medic 20 Medic 41

Unit(s) Unit Location

Medic 10 Sonora

Medic 11 East Sonora

Medics 12, 13 &14 Flexibly Deployed

Medic 20 Soulsbyville Medic 41 Groveland


Call Volume 2007 by Days of the Week A breakdown of requests by day and time of day shows that call volume is fairly consistent during the week with the hours of 8 a.m. to 5 p.m. being the busiest hours of service. The chart below illustrates that Monday is the busiest day of the week, followed by Friday. The chart also shows that Sunday is the slowest day followed closely by Wednesday.

2007 Call Volume by Day of the Week

681746

687653664776

642

0100200300400500600700800900

Sunda

y

Monda

y

Tues

day

Wed

nesd

ay

Thur

sday

Frida

y

Saturda

y

2007 Call Volume by Hour of the Day

119127165

185211228

288273249

287278294306268

207199143

1077268699491122

050

100150200250300350

0:00

1:00

2:00

3:00

4:00

5:00

6:00

7:00

8:00

9:00

10:0

0

11:0

0

12:0

0

13:0

0

14:0

0

15:0

0

16:0

0

17:0

0

18:0

0

19:0

0

20:0

0

21:0

0

22:0

0

23:0

0


Call Volume 2007 The breakdown of EMS requests by location reveals that the majority (60%) of requests occur in the suburban areas of Tuolumne County, where the majority of Tuolumne County residents live.

2007 Calls by Population Density

24266

1613

2912

0

500

1000

1500

2000

2500

3000

3500

Urban Suburban Rural Wilderness

2007 Call Volume by Map Zone856

559

25318414684664835201140

100200300400500600700800900

Jack

sonv

ille

Che

rry V

alle

yC

arso

n Ic

eber

g S

traw

berry

Em

igra

nt/Y

osem

Don

Ped

roM

occa

sin

Col

umbi

aLo

ng B

arn

Sm

ith S

tatio

nD

odge

Rid

geP

onde

rosa

Hill

sC

edar

Rid

geC

hine

se C

amp

Pin

ecre

stM

iwuk

-S

CC

Cry

stal

Fal

lsTw

ain

Har

teC

olum

bia

Mon

o V

ista

Jam

esto

wn

Gro

vela

ndTu

olum

ne C

ityM

ono

Vill

age

Son

ora

City

Son

ora

CD

F/C

O


Call Disposition The table below illustrates 74% of all requests resulted in the patient being transported to an emergency department.

2007 Call Disposition

Emergency Department

74%

Dead On Scene1%

Refused AMA3%

SNF4%

No Patient Contact < 1%

Other1%

Hospital (non-ED)12%

Non-Hosp. Medical Facility

2%

Rendezvous Point2%

Released from Scene< 1%

Residence1%

75% of all requests resulted in the delivery of advanced life support (ALS) procedures and medications administered to the patient.

2007 Level of Care

3586

1255

0500

1000150020002500300035004000

ALS BLS


Calls by Type In 2007, scene emergencies accounted for 77% of the total EMS requests for service. Transfers make up the remaining 23% of EMS requests for services, and consisted of ambulance interfacility transfers, air ambulance transfers from a hospital to a landing site, critical care transfers, and 4% transfers to and from a patient’s home to a hospital, transports for diagnostic service such as transporting a patient for an MRI.

2007 Calls by Type

Scene77%

SCC to Hospital

< 1%

Inpatient Tansport

< 1%

Other1%

Hospital to home/SNF

2%

Hospital to Landing Site

1% Critical Care Transfer

1%

Home/SNF to Hospital

1%

Intra Campus Transfer< 1%

Inter-fac. Transfer

17%

Nurse Transfer < 1%


Response Times The State of California Emergency Medical Services Authority has established recommended guidelines for Code 3 response time standards to EMS requests, based on population density. The State of California Emergency Medical Services Authority recommends that EMS responses meet these response time guidelines at least 90% of the time.

BLS First Response

BLS AED First Response

ALS Ambulance

Urban = 101 to 500 people per square mile

5 minutes

5 minutes

8 minutes

Suburban = 51 to 100 people per square mile

15 minutes

ASAP

20 minutes

Rural = 7 to 50 people per square mile

15 minutes

ASAP

20 minutes

Wilderness = less than 7 people per square mile

ASAP

ASAP

ASAP

The chart below shows the 90th percentile Code 3 response time for an ALS ambulance in the urban area of Tuolumne County is 10.00 minutes with an average response time of 6.32 minutes. In Tuolumne County, only the City of Sonora is classified as an urban area. See tables on this page and next two pages.

2007 Code 3 Urban Response Times

8 - 19.99 Minutes

30%

0 - 7.99 Minutes

69%

20 - 29.99 Minutes

1%

> 29.99 Minutes < 1%

Code 3 Response Time Interval in Minutes (Urban) Minimum Response Time 0.00 minutes Maximum Response Time 34.00 minutes Average Response Time 6.32 minutes Standard Deviation 3.53 minutes 90th percentile 10.00 minutes 95th percentile 11.00 minutes


The chart below shows that the 90th percentile Code 3 response time for an ALS ambulance in the suburban areas of Tuolumne County is 16:00 minutes with an average response time of 10.21 minutes. Suburban areas of Tuolumne County include the map zones for Mono Village, Mono Vista, Crystal Falls, Cedar Ridge, Sonora CDF, Moccasin, Twain Harte, Tuolumne City, Columbia, Jamestown, Mi-Wuk/Sugarpine, Groveland and Columbia College.

2007 Code 3 Suburban Response Times

0 - 19.99 Min94%

> 29.99 Min1%20- 29.99 Min

5%

Code 3 Response Time Interval in Minutes (Suburban) Minimum Response Time 0.00 minutes Maximum Response Time 76.00 minutes Average Response Time 10.21 minutes Standard Deviation 5.79 minutes 90th percentile 16.00 minutes 95th percentile 20.00 minutes

The chart below shows that the 90th percentile Code 3 response time for an ALS ambulance in the rural areas of Tuolumne County is 40:00 minutes with an average response time of 25.91 minutes. Suburban areas of Tuolumne County include the first response areas of Dodge Ridge, Pine Crest, Strawberry, Long Barn, Don Pedro, and the Sierra Conservation Center.

2007 Code 3 Rural Response Times

0 - 19.99 Minutes

37%

20 - 29.99 Minutes

27%

> 29.99 Minutes

36%

Code 3 Response Time Interval in Minutes (Rural) Minimum Response Time 2.00 minutes Maximum Response Time

63.00 minutes

Average Response Time

25.91 minutes

Standard Deviation

11.39 minutes

90th percentile

40.00 minutes

95th percentile

49.00 minutes


The chart below shows that the 90th percentile Code 3 response time for an ALS ambulance in the wilderness area of Tuolumne County is 64:00 minutes with an average response time of 39.82 minutes. Wilderness areas of Tuolumne County include the Portions of the Immigrant Wilderness, Carson Iceberg Wilderness, Yosemite National Park, and the Cherry Lake Area.


2007 Wilderness Response Times0 - 19.99 Minutes

9% 20 - 29.99 Minutes

18%

> 29.99 Minutes

73%

Code 3 Response Time Interval in Minutes (Rural) Minimum Response Time 7.00 minutes Maximum Response Time

108.00 minutes

Average Response Time

39.82 minutes

Standard Deviation

20.33 minutes

90th percentile

64.00 minutes

95th percentile

64.00 minutes

PATIENT AND HOSPITAL DATA

Primary Illness/Injury Complaint

Patients

% of total

Cardiac 619 13% Environmental 8 <1% Medical 1332 28% Neurologic 715 15% Poisoning* 99 2% Respiratory 438 9% Obstetric 22 <1% Psychiatric 270 6% Trauma 1318 27%

2007 Primary Complaint

Medical28%

Neurologic15%

Trauma27%

Cardiac13%

Environmental<1%

Psychiatric6%

Respiratory9%

Obstetric<1%

Poisoning2%

* Poisoning/Overdose category does not differentiate between accidental and intentional ingestion or overdose. Nor does it differentiate between prescription and illicit drugs. Medication reactions and anaphylaxis are included in the Medical category.


As shown in the chart below, for those patients transported to a hospital in Tuolumne County approximately 52% of all transports are made to the hospital of the patient’s or families’ choice.

2007 Patient Distribution by Destination Decision

Nearest Hosp28%

Patient Request

52%

Specialty Center

2%Trauma Center

1%

Other5%

Base Hosp Order<1%

Diversion<1%

MD Request12%

With the closure of Tuolumne General Hospital (TGH), Sonora Regional Medical Center (SRMC) has experienced a 75% increase in the number of patients transported to their hospital by Tuolumne County Ambulance, when compared to CY 2006. The chart below shows the patient distribution by receiving facilities, including transfers.

2007 Patient Distribution by Hospital

3036

5912921988020

0

500

1000

1500

2000

2500

3000

3500

UCDMC MMC DMC Other TGH SRMC

2007 Patient Distribution from Scene Call

276275 311264257271220198183206188196

1479696867389

050

100150200250300350

Jan

Feb

March

April

MayJu

ne July

AugSep

tOct Nov Dec

Sonora Regional Medical Center Tuolumne General Hospital


Does not include interfacility transfers

Residency Status of EMS Patients In 2007, people living in Tuolumne County generated 80% of requests for EMS services. 15% of the requests were generated by people who reside outside of Tuolumne County, and the residency status of 5% of the patients is unknown. All Patients

Residency Status

% of Patients

Tuolumne County Resident 80%

Non- Tuolumne County Resident 15%

Unknown Residency Status 5%

2007 Patients by Tuolumne County Resident Status

Residents80%

Unknown5%Non-

Residents15%

2007 Patients by Residency Type in Wilderness Map Zones

1 1

4

2

1

3

0

2

4

6

8

Emigrant/Yosemite Cherry Valley Carson Iceberg

Unknown Local Resident Out of County Resident


2007 Patients by Residency Type in Rural Map Zones

23

1

3

1

0

1

2

3

4

5

Calaveras Co. Mariposa Co.-Greeley Hill Area

Jacksonville Long Barn


2007 Patients by Residency Type in Rural Map Zones

1 1 42

20

24 5

6

14

2

0

5

10

15

20

25

Don Pedro Strawberry Dodge Ridge SCC Pinecrest



2007 Patients by Residency Type in Suburban Map Zones

11 10 63 3

3 313

620

510

1520

25

PonderosaHills

Cedar Ridge Chinese Camp Moccasin ColumbiaCollege



126190

45 43 56 221266

5

11

8 513

050

100150200250

Mono Village SonoraCDF/CO

Groveland Tuolumne City Jamestown




5 6

38 4133 30

20

7

5

121

1

33

0

10

20

30

40

50

Mono Vista Columbia Crystal Falls Twain Harte Miwuk-Sugarpine


2007 Patients by Residency Type in Urban Map Zones

111215

74

70

17

0

100

200

300

400

Sonora City Transfers



2007 EMS Demographics As the chart below shows, patients greater than 64 years of age account for 46% of ambulance patients. Males comprise 47% of ambulance patients and 53% are females. The average age of ambulance patients is 60 years old; males average 58 years old and females average 68 years old.

65 60142 121

265 288456 458

372 355

957

1281

0200400600800

100012001400

0 - 13years

14 - 21years

22 - 39years

40 - 54years

55 - 64years

> 64years

2007 Patients by Age and Gender

Male Female

TRAUMA SYSTEM The chart below shows the mechanism of injury for major trauma victims in Tuolumne County in 2007. Motor vehicle accidents with speeds greater than 35 miles per hour are the greatest mechanism of injury for major trauma victims in Tuolumne County.

2007 Major Trauma Victims by Mechanism of Injury

13

9

4422

1111102468

101214

MCA < 35

MPH

MCA > 35

MPH

Ped/B

icycle

vs. V

...

Bicycle

Acc

ident

Snow Skiin

g

Other A

ssau

lt

Animal

Riding

Ac..

.

MVA < 35

MPH

Fall <

20 Fe

et

Ground

Leve

l Fall

MVA > 35

MPH


2007 Major Trauma Patients by Trauma Triage Criteria

GSC Motor Score18%

Skull Fracture

18%

Pelvic Fracture

9%

Mult. Long Bone

Fractures18%

Crushing Injury9%

Paramedic Judgment

28%

Trauma Demographics

In 2007, a sampling of data shows that people living in Tuolumne County generated 40% of requests for EMS services due to major trauma. 40% of requests were generated by people who reside outside of Tuolumne County and the residency status of 20% of the patients is unknown. Trauma Patients

Residency Status

% of Number

Tuolumne County Resident 40%

Non- Tuolumne County Resident 40%

Unknown Residency Status 20%

2007 Major Trauma Patients by Tuolumne County Residency Status

Unknown20%

Tuolumne County

Resident40%

Non-Tuolumne County

Resident40%

Triage Criteria

% of Total

GSC Motor Score 18% Skull Fracture 18% Pelvic Fracture 9% Multiple Long Bone Fractures 18% Crushing Injury 9% Paramedic Judgment 28%

The Tuolumne County Trauma Plan has defined nine separate trauma triage criteria. The criteria are designed to categorize those trauma patients with an increased risk of mortality and morbidity due to their injuries. Paramedic judgment was the criteria used 28% of the time.


As the chart below shows, major trauma patients’ ages 40-54 accounted for 31% of all scene requests and females have surpassed males in number, accounting for 51% of all major trauma patients.

2007 Major Trauma Patients by Age and Gender

3

7

4

11 1

57

5

32

012345678

0 - 13 years 14 - 21years

22 - 39years

40 - 54years

55 - 64years

> 64 years

Male Female

The Tuolumne County Trauma Plan has identified three major trauma patient destinations.

1. Doctors Medical Center (adult) 2. Memorial Medical Center (adult) 3. U.C. Davis Medical Center (adult & pediatric)

However, under some circumstances major trauma patients may be taken to another Trauma Center, such as Sutter Roseville Medical Center, or other non-Trauma Center Hospital.


ADVANCED LIFE SUPPORT SKILLS Infrequently used skills are skills that are not likely to be used by a Paramedic once in a six-month period. Commonly Used Skills are skills that are likely to be used by a Paramedic more than once in a six-month period of time. Continuous Positive Airway Pressure (CPAP) is considered successful if the patient’s level of respiratory distress decreases. CPAP may be performed correctly, but if no change occurs, it is considered unsuccessful.

2007 Infrequently Used Skills by Patient

44

6 11 8 1 10

1020304050

CPAP

ET

intu

batio

n,O

ral &

Nas

al

Com

bitu

be o

rEO

A

Nee

dle

Thor

acos

tom

y

Intra

osse

ous

Infu

sion

Successful Unsuccessful


ADVANCED LIFE SUPPORT MEDICATIONS The charts below represent the number of times a medication was administered and how many patients received the medication.

2007 Medicatiions by Patient and Administration #1

1 3 5 7 914 13 14

1 37 7 9

16 1723

05

10152025

Cal

cium

Chl

orid

e

Sod

ium

Bic

arbo

nate

Dop

amin

e

Glu

cago

n

Lasi

x

Lido

cain

e

Ade

nosi

ne

Epi

1:1

,000

Patients Administrations

2007 Medication by Patient & Administration #2

2446

6046

82

4724

53 61

89

118132

020406080

100120140

ActivatedCharcoal

Benedryl Dextrose50%

Atropine Narcan Epi1:10,000



2007 Medication by Patient and Adminstration #3

110 161239

346446

162 196 245

710856

0

200

400

600

800

1000

Versed Proventil Aspirin Nitro MorphineSulfate




SUMMARY I would like to thank Tuolumne County Ambulance Service, and Sonora Regional Medical Center for providing the data that made this report possible. I would also like to thank all of the First Response Agencies for the excellent service they provide to the County of Tuolumne. The Tuolumne County EMS System remains a strong asset to the County and its citizens and visitors. 2007 has been the busiest in the history of Tuolumne County EMS; the seven-year trend shows a general increase in calls for EMS service, particularly along the Highway 108 corridor. The response times for scene calls have remained fairly constant. The changing environment of the upcoming years will afford us many opportunities to improve the EMS System. The decreasing reimbursement for services rendered and increasing costs will provide many challenges to the County of Tuolumne, maintenance and expansion of the EMS system should be one of the top priorities of the County. The almost constant evolving science of prehospital medicine will require updating of treatment guidelines, training practices, and equipment.

2007 statistical report

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